Global Overview of Measles & RubellaGlobal Overview of Measles & Rubella

11th Annual Meeting The Measles Initiative

Washington, DC18-19th September, 2012

Major causes of annual under 5yrs child mortality: 1990-2010

2000 : 9.6 million

2010 : 7.6 million

Source: Li, Liu, at all The Lancet 379, June 9, 2012):

1990: 12.1 million

2008: 8.8 million

Source: Van den Ent et al, J Infect Dis Suppl July 2011

020

040

060

080

010

00E

stim

ated

dea

ths,

thou

sand

s

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010Year

Estimated mortality 95% confidence interval

Estimated measles deaths down by three - quarters, 2000 - 2010 Estimated measles deaths down by three - quarters, 2000 - 2010

2015 Target

74%

4 |

Trends in 1st and 2nd dose Measles delivery various strategies

Trends in 1st and 2nd dose Measles delivery various strategies

Number of doses of measles vaccine administered, by delivery strategy, 2000-2010

Measles Initiative

1st routine dose: WHO/UNICEF coverage estimates, The World Population Prospects New York, 2011. 2nd routine dose: WHO/UNICEF Joint reporting form, (not all countries report 2nd dose). SIA dose;: WHO SIA database, July 2011 (Provisional data)

0

50

100

150

200

250

300

350

400

450

500

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Num

ber o

f MC

V d

oses

(in

mill

ions

)

1st routine dose 2nd routine dose SIA

1 billion vaccinated as of July 2011

Measles and other interventions supplementary activities, 2011Legend

maskline_general

COUNTRY

Abyei border

Abyei border1

Bline_Kosovo

Bline_Sudan

Cont_ja_ka

Fline

Gaza

South_sud

Wline

Measles_SIAs<all other values>

Measles_2011_2012.ImpStatus

<Null>

MR

OPVMeasles

OPVVitAMeasles

VitADewormingMeasles

VitAMeasles

all*

measles

maskpoly_general

AREA

Abyei

Jammu and Kashmir

Lakes

ISO_3_CODE

ESH

<all other values>

Vitamin A – 12De-worming – 10Bed nets – 2OPV – 16Other interventions -5

WHO;August 2012

*OPV+VitA+Deworming+Mealses

0 3,250 6,5001,625 Kilometers

6 |

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

4,000,000

4,500,000

5,000,0001

98

0

19

81

19

82

19

83

19

84

19

85

19

86

19

87

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

20

09

20

10

20

11

num

ber

of

cases

0

10

20

30

40

50

60

70

80

90

100

imm

uniz

ation c

overa

ge (

%)

Number of cases WHO/UNICEF estimates

84%2015 Target

Annual Number of Reported Measles Cases and 1st Dose Measles Vaccination Coverage, Worldwide, 1980-2011

7 |

Reduction in Estimated Measles Deaths by WHO Region 2000 to 2010

Reduction in Estimated Measles Deaths by WHO Region 2000 to 2010

74%76%79% 85%

2010 reduction goal (90%)

78%

Source: WHO/IVB, November 2009

87%100%

26%

8 |

Pareto-Juran principlePareto-Juran principle

20% of the work (the first 10% and the last 10%) consume 80% of your time and resources

9 |

IndiaIndia

RAJASTHAN

ORISSA

GUJARAT

MAHARASHTRA

MADHYA PRADESH

BIHAR

KARNATAKA

UTTAR PRADESH

ANDHRA PRADESH

JAMMU & KASHMIR

ASSAM

TAMIL NADU

CHHATTISGARH

PUNJAB

JHARKHAND

WEST BENGAL

ARUNACHAL PR.

HARYANA

KERALA

UTTARAKHAND

HIMACHAL PRADESH

MANIPUR

MIZORAM

MEGHALAYANAGALAND

TRIPURA

SIKKIM

GOA

A&N ISLANDS

D&N HAVELI

PONDICHERRY

LAKSHADWEEP

DELHI

CHANDIGARH

DAMAN & DIU

Phase 2 (157 districts)

Phase 1 (45 districts covered)

Remaining (159 districts)

Source: Based on target population available with GoI

Target pop

(millions)

Vaccinated (millions)

Coverage

Phase-1 13.8 12.1 88%

Phase-2 42.9 28.6 67%*

Phase-3 72.7 Planned --

Total 129.4 40.7* --

* Phase-2 campaigns ongoing; data as on 23 Jan 2012.

17 states with MCV1 coverage ≥ 80% introduced a routine second dose by August 2011.

14 states with MCV1 < 80% are implementing measles SIAs

10 |

Measles and Rubella Elimination Goalsby WHO Region, February 2012

Measles and Rubella Elimination Goalsby WHO Region, February 2012

20152015 20152015

2015201520122012

SEAR: 95% Mortality Reduction by 2015

Americas, Europe, E. Mediterranean, W. Pacific, Africa have measles elimination goalsAmericas and Europe have rubella elimination goals

20202020

2000 2000 20102010

Political advocacy, mobilizing decision makers Branding,

advertising & ‘edu-tainment’ with national, provincial and community mass media

Community engagement Meetings, forums, film showings and events

Targeted sellingVolunteer Social Mobilization Networks

Point of service promotion Inter-personal communication

Researched & Evidenced multi-

pronged communication: Experience from

GPEI

COMBI Star adapted for polio eradication

Challenges 1: Communication

12 |

Challenges 2: Weak Immunization Systems Challenges 2: Weak Immunization Systems

1st dose:– 67 Countries have

MCV1 coverage < 90%

2nd dose ( routine ):– 54 countries do not

have routine 2nd dose

Campaigns:– Variable quality

Measles 1st dose coverage among infants, 2010

80-89% (24 countries or 12 %)

50-79% (41 countries or 21%)

>=90% (126 countries or 66%)

<50% (2 countries or 1%)

13 |

Challenges 3: Some set backs in AfricaChallenges 3: Some set backs in Africa

4-fold increase since 2008

Large outbreaks in Burkina Faso (2009), S. Africa (2010), and DRC (2011)

Outbreaks in drought affected Horn of Africa

– High case-fatality

0

100,000

200,000

300,000

400,000

500,000

600,000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010‡

Year

No.

of c

ases

(in

thou

sand

s)

0

10

20

30

40

50

60

70

80

90

100

MCV1 coverage (%

)

Number of cases

WHO/UNICEF estimates

Administrative coverage

Weekly Epidemiological Record(2011) 86:129-135

14 |

Historical procurement of Measles and MR vaccine through UNICEF in 2000-2012 and forecasts for 2013-2016 (in doses)Historical procurement of Measles and MR vaccine through

UNICEF in 2000-2012 and forecasts for 2013-2016 (in doses)

15 |

SummarySummarySummarySummary

Achievements– 1st dose coverage up to 85%– 1 billion doses delivered in campaigns– 2 / 3 reduction in cases– 3 / 4 reduction in deaths

Challenges– Catch - up in India; Outbreaks in Africa; Weak systems

New Strategic Plan, 2012 – 2020– Addressing rubella together with Measles– Taking the Initiative towards achieving regional goals

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